<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name" data-rule="required" class="form-control" name="row[name]" type="text" value="{$row.name|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Supplier_name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-supplier_name" class="form-control" name="row[supplier_name]" type="text" value="{$row.supplier_name|htmlentities}">
        </div>
    </div>
<div class="form-group">
    <label class="control-label col-xs-12 col-sm-2">{:__('Quantity')}:</label>
    <div class="col-xs-12 col-sm-8">
        <input id="c-quantity" class="form-control" step="0.01" name="row[quantity]" type="number" value="{$row.quantity|htmlentities}" onchange="calculateAmount()">
    </div>
</div>
<div class="form-group">
    <label class="control-label col-xs-12 col-sm-2">{:__('Unit_price')}:</label>
    <div class="col-xs-12 col-sm-8">
        <input id="c-unit_price" class="form-control" step="0.01" name="row[unit_price]" type="number" value="{$row.unit_price|htmlentities}" onchange="calculateAmount()">
    </div>
</div>
<div class="form-group">
    <label class="control-label col-xs-12 col-sm-2">{:__('Amount')}:</label>
    <div class="col-xs-12 col-sm-8">
        <input id="c-amount" data-rule="required" class="form-control" step="0.01" name="row[amount]" type="number" value="{$row.amount|htmlentities}" readonly>
    </div>
</div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Receipt_image')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-receipt_image" class="form-control" size="50" name="row[receipt_image]" type="text" value="{$row.receipt_image|htmlentities}">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-receipt_image" class="btn btn-danger faupload" data-input-id="c-receipt_image" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp,image/webp" data-multiple="false" data-preview-id="p-receipt_image"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-receipt_image" class="btn btn-primary fachoose" data-input-id="c-receipt_image" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-receipt_image"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-receipt_image"></ul>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Remark')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-remark" class="form-control" name="row[remark]" type="text" value="{$row.remark|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
